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IT Solutions

IT Solutions

Over the last decade in the KSA, there has been a multifold increase in the penetration of healthcare insurance. This has resulted in high dependence on revenue from insurance companies. The KSA health insurance regulations change frequently to meet the local needs, and with the introduction of NPHIES, It becomes vital for Healthcare Providers to implement an efficient revenue cycle management system that is designed to meet the local requirement and is flexible to adapt to these changes quickly.


  • Best in class healthcare technology components with all the required application features available
  • Cloud ready web-based interface with mobile support
  • Local support Centre staffed with experts who are prepared to provide immediate assistance both
    onsite and remotely.
  • Solution designed to support Integration with NPHIES
  • Robust integration capabilities in different aspects of the operation whether on order level to run
    validations and medical necessity checks or on billing level and claim management
  • Multi Tenet Architecture that supports both Central and non-central operations

Solutions and Services

Medical Coding and Claim Management:

The management of revenue cycle processes – including billing and reimbursements – can be time- consuming and complex for a healthcare organization. Challenges include understanding and managing all reimbursement rules, regulations, and payor-specific variables in addition to tracking down the required supporting clinical details from within the organization which may prove difficult as well.

Using Our System users will be able to easily create, manage and validate their claims with a couple of simple steps, and / or use one of the bulk actions to processes more than one claim at the same time without risking their quality thanks to its validation engine and workflow.


Highlighted Features:

Claim processing: Our System will allow the medical coders to review claims, justify them, and make sure that they are meeting the coding rules and guidelines in a very simple and efficient user interface.

The users can easily track changes on an individual claim and validate it through the validation engine ensuring that it is technically correct and is following the providers internal and contractual rules and guidelines.

Online Claim Verification: To help reduce rejections, Our System will allow users to submit the claims for online testing, report errors for each claim, and help users to fix the errors before actual submission.

Work Force Management: Our System is designed with the needed process and activities to maintain productive workforce, it helps supervisors and team leaders plan work responsibilities and duties, by matching employee skills to specific tasks over time, design team and work queues, and tracking results of the work efforts.

Claim Submission and Batch Management: Our System support both individual claim submission as well as batch submissions, in both cases the users are not allowed to submit any unvalidated and approved claims, upon completing the submission claims change their status in Our System to prevent any changes ensuring the integrity of the data until Remittances advises are posted. The system will notify the users upon a successful submission and will provide summaries for each.

Manual Remit utility: is an embedded utility within Our System RCM designed to be used by team leaders and supervisors to correct any invalid posted remittances by the payers, the users can easily remap the claim with the corrected RA file and or use an external file to correct it.

Denial Management:upon usefully mapping the remittance to a claim the system will capture denials and helps the user in analysing trends and identifying key issues that resulted in these denials and clearly displaying the associated denial reason descriptions and codes, this will help make informed, knowledgeable actions within those rejected areas all while maintaining the full history of the claim in all its previous iterations both record and price wise.

Contract Management:

The Contract Management Module provides the ability to manage and contracts and master data in a central repository accessible by both the IT department and the Business. The information contained within the application relates to all Clinical Services provided by HealthCare Entities. It is designed to enhance and easily manage contracting data of the client across all its Facilities. The Contract Hierarchy is comprehensively structured to meet the demands of the healthcare industry. It allows you to standardize and automate your contract processes for the physicians, allied health professionals and vendors.

Key Features:

Building and managing master data:

  • Clinicians Master
  • Insurance masters
  • Define Code types for both standard and Internal non-standard codes

Importing and Exporting data
Defining Insurances and TPA’S
Corporate Insurance Plans
Cash Plan Definitions
Insurance Policy definition
Insurance Contractual Agreement Management
Easy to navigate and Provide useful, timely content in a compelling, easy-to-use design to manage data
User control and freedom. Includes undoing and redoing previous actions
Easy to use search capabilities to find existing contracts quickly

E-Authorization Engine

The System is bundled with an E-Authorization Module that support for eligibility checks to validate whether the patient is an eligible member with the payer.